1. Technical Field
This invention generally relates to surgical implements and procedures. More particularly, the invention relates to a device for installing surgical screws and a method of using the same. Specifically, the invention relates to a clip for retaining a surgical screw on the tip of a screwdriver shaft.
2. Background Information
Very small screws are frequently used in surgical procedures to secure components together. These procedures include dental reconstruction of the mandible or surgery on hands or other small bone body regions. In mandible surgeries, for example, where the jawbone is damaged and the surgeon must reinforce and stabilize the bone with special multi-holed titanium plates, tiny titanium screws are used to secure the plates to the jawbone. Surgeries of this type typically are conducted using a special tool kit that is delivered to the operating room in a sterile condition. The tool kit will include an assortment of plates, plate benders, cutters, screwdrivers and a full assortment of screws. The kit may include drawers that store all of these components. A mandible kit, for example, would include a screw caddy or insert tray that typically will have storage for thirty-six 2.0 mm screws of various lengths and thirty-six 2.4 mm screws of various lengths. The screws are all retained tip down in the holes in the plastic tray and each hole has a sequential number for each screw diameter. Just the head of the screw sticks up about around ⅛″ or 3 mm above the numbered surface of the tray. Furthermore, the groups of each screw length are slightly separated from the others to aid selection of the length as the rest of the screw is not visible to the surgical staff. The sequential numbering is important as the surgical team conducts a count of the screws missing from the tray verses how many screws are visible in the patient prior to closing up the patient's tissue and skin.
During surgery, the surgeon first bends and adjusts a titanium plate to the bone's anatomical surface and then, holding the fitted plate in place, drills a small hole in the bone through one of the holes in the plate. The surgical staff person who is assisting the surgeon takes a tiny titanium screw from the caddy. The screw may be as small as 2.0 mm in diameter and between 4.0 mm and 18.0 mm in length. The screw is positioned and balanced on the tip of a dental screwdriver and then the driver is passed to the surgeon. The surgeon must then hold the plate in place and try to engage the screw in the bone.
The surgical screws used in these procedures tend to have very shallow heads so as not to create bumps in the skin. Furthermore, most of the screws do not have socket type drives but, instead, have a very shallow X-shaped groove that tends to cause axial misalignment of the screw to the driver. Consequently, there is not much interlocking engagement between the screw and driver to aid in holding the screw on the tip thereof. Furthermore, surgical screws are not self-tapping as the tip may need to protrude through to the opposite side of the patient's bone. The lack of a pointed tip on the screws also adds to the surgeon's challenges in lining the screw up with the hole in the bone and in beginning to engage the screw threads in the bone. Surgeons complain of the enormous quantity of time wasted due to the operating room staff dropping screws as they pass the driver to the surgeon. They also complain of their need to use only one hand to operate the driver and start the screw in the drilled hole as their other hand is occupied in stabilizing the plate on the bone. The need to keep the screw on the tip of the driver while at the same time angling the driver to insert the screw tip into the drilled hole, also frequently results in the surgeon themselves dropping the screws into the patient's body. Any dropped or lost screws in the body cavity will absolutely cause infection and complications and potential liability issues and these screws have to be located and removed. The surgeon must then pass the driver back to the surgical staff and wait for them to load a new screw onto the driver so that they can attempt the procedure yet again. Aids like wax are often used in an attempt to retain the screws on the driver tips. Apart from being a questionable practice from a sterility aspect, the wax tends to also cause the driver to slide and slip on the screw head when the screw is being tightened, making installation more difficult. Rarely does a complex surgical procedure go by without at least one screw being dropped. The dropped screws cannot be used as they are no longer sterile and must be put aside and retained for the final screw count. Considering that these titanium screws each cost around $50 or more and that a typical mandible surgery, for example, can require ten to sixteen screws, the financial cost of the dropped screws, together with the cost in time lost in dropping and engaging new screws, tends to add substantially to the spiraling costs of healthcare.
There is therefore a need in the art for an improved system for engaging surgical screws with screwdrivers and for retaining the same in place until the tips of the screws are captured in the bone.